Q: What are the prospects for turning Medicaid into block grants to the states?
“Block-granting is one of those policies that people have a romance for, particularly people on the right. And Medicaid block grants particularly are something that many governors, and sometimes even Democratic governors, feel romantic toward because implicit in it is that the federal government would give them a pot of money.
“These governors look at this and think it would allow them to really impact their healthcare system and, frankly, control their budgets. That’s the easy part. That’s the conceptual part. The dilemma is the money. Show me the money.
“Medicaid is a complicated program. Not only is it byzantine in terms of how people qualify for it and who actually provides care, it’s long-term care for the elderly disabled; it’s the acute-care part of Medicaid; and then there’s the ACA expansion.
“It’s even more complicated on the payment side. No one could tell you right now with any accuracy what the real match rate is because states have all these adjustments and waivers. And on top of that, they have taxes and other ways to capture Medicaid money.”